SAT-157 THE SAVING YOUNG LIVES PROGRAM: PROOF OF PRINCIPLE AND OVERCOMING BARRIERS

Abstract

The Saving Young Lives Program (SYL) was established in 2012 as a partnership between the International Society of Nephrology (ISN), International Society for Peritoneal Dialysis (ISPD) and the International Paediatric Nephrology Association (IPNA). They, in collaboration with the Sustainable Kidney Care Foundation (SKCF) strove to develop sustainable programs in low and low middle income countries, aimed at treating patients with acute kidney injury (AKI) primarily with the use of peritoneal dialysis (PD). The ISN 0 by 25 initiative was launched in 2013 aiming to reduce mortality from AKI in developing countries by the year 2025. In order for this to succeed, dialysis provision needed to increase, and in countries with no access to running water or electricity the only option is acute peritoneal dialysis. Hence the SYL has offered a pivotal role in driving this agenda. The principles of the program include education and hands on training, mentorship and during the first 5 years, through collaboration with the SKCF, the provision of dialysis supplies. In 2016 the grant funding the SKCF expired and the provision of supplies ceased. Subsequently the program has shifted its attention primarily to education and training and logistical support for the SYL supported units. In 2017 EuroPD joined as an equal partner in the SYL program. The SYL program initially developed 10 sites in partnership with local champions - 9 in Africa and 1 in Cambodia. Subsequently the number of sites has expanded exponentially and SYL is now developing training programs in India and South East Asia. Education is provided through numerous hands-on workshops provided by the Red Cross Children’s Hospital where SYL sponsored teams of doctors and nurses from countries in Africa attended to learn how to manage paediatric patients with AKI and how to insert PD catheters in adults and children. These have been supplemented with workshops at regional meetings and congresses. To date 224 doctors and nurses have been trained at these formal courses, however funding has also assisted educational ambassadors to travel to countries such as Malawi and Cote D’Ivoire and provide in-depth training and support. The program has recorded data on 364 cases with an estimated 40-50 cases yet to be submitted. The mean age of patients was 11.6 years, and the commonest cause for AKI was malaria (48%). Survival to hospital discharge was 75.5%, however some patients were found to have chronic kidney disease and therefore not expected to survive (10.5%). This equates to overall survival in 65% of cases. During the past seven years there have been a number of challenges which have had to be overcome, the most significant of which has been difficulty in sourcing commercially produced PD solutions. This has been overcome by teaching units to prepare solutions locally using Ringers lactate solution with the addition of dextrose. One of the SYL sites has published data recently demonstrating this to be a safe practice with no significant difference in peritonitis rates. The SYL program has successfully proven the principle of developing effective acute PD programs in low resource environments through education and mentorship. With continued expansion into Asia and South America it is envisaged that the success demonstrated in Africa will be replicated around the world.